Obama's "2nd executive order" regarding HIPAA may not be a good idea

Listening to a psychologist(?) on NPR yesterday, and reading a few blog posts today. The basic worry appears to be that when patients grappling with violent and/or suicidal thoughts know that they might be reported by their therapist, they just aren't going to get treatment. The net effect will be fewer people treated, not more.

Guns and Mental Health

Here's a .pdf of the twenty-three executive orders and actions that the president initiated just after noon today. The second item allows mental health professionals to report patients who they think are a risk to the community. I worry about that. It's one of the main ways we might have avoided the massacres in Tucson, Aurora, and Newtown, but it also will create a powerful incentive for people steeped in our gun culture to avoid seeking routine psychiatric or psychological care. It's kind of a Catch-22, frankly. You might catch someone who is mentally ill before they can kill a bunch of people. But you also might create a situation where a LOT of mentally ill people go without treatment.

I am not clever enough to know how to get around this conundrum, but I fear that the net effect of that particular executive order will be negative.

8. in a word, yes. here's why

The argument is basically a numbers game. I'm going to relate what this therapist on NPR was saying: which is that he works with many patients who have violent or suicidal thoughts at one point or another. The probability that such thoughts lead to actions in any patient is very, very low. Furthermore, there is absolutely no useful way to identify when there is any kind of elevated risk of actual violent behavior.

So, with that all in mind, how does this play out? It puts therapists in the position of needing to report many people for no reason, because there's no way to tell who would "really" need to be reported, and a false negative will go quite badly for them. Patients immediately discover that going to a therapist to try and work out thoughts of violence is going to get them reported. So, who would go? Nobody.

So, what you end up with is almost nobody getting help with violent or suicidal thoughts. Nobody being reported, and if they are reported, it is far more likely that it was unnecessary than otherwise.

This does not sound like a win to me. It's a net worsening of the situation

11. Very Interesting, thanks!

22. My thoughts exactly. The psychologist's couch should have the sanctity of confession.

If someone thinks they're going to get put on the "psycho list", or get Baker-acted and thrown in the psych ward for a 72 hour hold because he discussed suicidal or violent thoughts with their shrink, they're not going to talk about those thoughts. In fact, they're not going to get treatment at all if they think it'll get them locked up, put on a list or stigmatized.

So yeah, I'm skeptical of mandatory-reporting requirements and other state-mandated breaches in the privacy required in a therapist/patient relationship.

5. Caught a minute of CNN as some microcephalic went on about "crazy people" and guns.

FUCK YOU CNN. You spew ableism as "news" and fact. You are doing far more harm than good. Why don't you do something about having LIED to the citizens of the US regarding conditions in Bahrain, because you were taking $$$ FROM Bahrain to lie about it? Amber Lyon says "Hi" on that count. Fuxers. 25% of US citizens suffer from some type and degree of "mental illness", and by that "logic" we'd be knee-deep in continuous bloodbaths.

15. No.

Mandated reporters are professionals who, in the ordinary course of their work and because they have regular contact with children, disabled persons, senior citizens, or other identified vulnerable populations, are required to report (or cause a report to be made) whenever financial, physical, sexual or other types of abuse have been observed or are suspected, or when there is evidence of neglect. Not every state has the same definitions or reporting. The things talked about today are not covered.

12. This has been a major concern of mine...

... The problem is, it polls well. But, as Andrew Rosenthal pointed out in a New York Times editorial concerning the section of New York's new gun regulations that requires such reporting, "screams unintended consequences."

New York’s new gun control bill further includes a peculiar provision requiring mental-health professionals to report patients who they believe constitute a threat to themselves or to others. It outlines how law enforcement could go about revoking those patients’ gun permits and/or confiscating their firearms.

That provision screams unintended consequences. Dr. Paul S. Appelbaum, the director of the Division of Law, Ethics, and Psychiatry at the Columbia University College of Physicians and Surgeons, told The Times that such a requirement “represents a major change in the presumption of confidentiality that has been inherent in mental health treatment.”

<Sigh> Why do we never seem to get it right when it comes to issues involving mental health in this country?

16. I also feel Duncan has little to offer, very very little

17. I think I heard the same NPR story you did and agree that this is potentially

very problematic.

I hope that the mental health professional community has the opportunity to be closely involved in developing the actual rules and protocols for this particular position. We need more and easier access to care and not anything that makes it harder.

19. Dr-Patient confidentiality saves lives because it keeps people from avoiding treatment.

20. I have concerns about this provision for another reason.

I've done professional work in the area of HIPAA and patient privacy. Mental health records are very closely protected, as well they should be. This part of the president's gun control agenda (which, by the way, I fully support) seems to portend a weakening of HIPAA privacy rules. I haven't studied the implications or Obama's proposals in any depth yet, but until now I can't quite wrap my head around how this type of information can be shared around.

23. Oh, a list of people with mental illness? What could possibly go wrong?

Um, I'm going to go curl up in the fetal
position in a dark, quiet room with Snow Patrol playing very softly in the background. Someone kindly let me know when the angry mob have taken their pitchforks and torches and gone away, thanks.